Revenue Integrity Analyst Pharmacy Administration
Resume:
SUSAN J BOWEN
*** ********* ****** ********, ** *9621 864-***-**** adl5hb@r.postjobfree.com
PROFILE
Offer extensive experience with a proven track record of competence, leadership, and dependability. Detail-oriented leader who excels in working independently as well as working collaboratively with departments across the organization.
EDUCATION
Bachelor of Human Services and Resources – Anderson University (Summa cum Laude)
Associate in Business Management – Tri County Technical College (Highest Honors)
CAREER BACKGROUND
Revenue Integrity Analyst – AnMed Health 2019-present
Pharmacy Supervisor - AnMed Health 1995-2019
Adjunct Instructor - Tri County Technical College 2020-present
State Certified Pharmacy Technician – CVS prn 2017-present
Store Manager – Revco/CVS 1994-1995
AnMed Health Revenue Integrity Analyst
Perform routine charge audits of various hospital cost centers via revenue reports to identify patterns of missing/undercharged/duplicated charges and ensure charge capture process issues are addressed
Work in tandem with Epic team to update charge master files as needed for new procedures, etc.
Monitor/manage Revenue Integrity, Revenue Guardian, and CFB work queues and address issues in a timely manner
Facilitate meetings with various cost center leaders for review of Charge Capture processes to optimize the charge capture process for each area
Ongoing partnership with department charge posters to maintain integrity and compliance with charging practices
Verify clinical documentation of identified missing charges through Waystar Charge Capture tool and collaborate as needed with various departments to ensure accuracy of charges. Add charges as appropriate
Lead bi-weekly conference calls with Waystar and organizational Billing/Coding stakeholders
Ensure timely response to all inquiries (phone, email) involving Revenue Integrity by reviewing patient clinical information as needed to verify/correct patient charges
Monitor late charges and items held in various department Charge Review work queues and communicate as needed with charge review staff in respective departments
Maintain tracking spreadsheet of debits/credits from key areas for monthly reporting
Proactively look for opportunities to optimize revenue capture and decrease revenue leakage across the organization
Investigate/research post-payment audits, engaging appropriate clinical staff to verify charges and to minimize lost reimbursement. Submit appropriate documentation and correspondence to payers for disputes
Maintain professional relationships across the organization with key stakeholders from each area
Accomplishments:
• Identified $1.7m in duplicate emergency level charges and collaborated with Coding/Epic to correct
• Identified causes of $25m budget variance for pharmacy
• Identified $300,000 in missing epidural charges
• Identified issue with missing charges in Cath Lab and EP lab by auditing AcuDose dispenses. Worked with pharmacy and CV services to correct processes ~$30,000
• After approval and Epic build, retroactively entered bedside procedures as identified by Waystar ~$110,000
AnMed Health Pharmacy Supervisor of Operations, Revenue Integrity, and Compliance
Supervised daily activities of technicians
Collaborated directly with senior management to achieve departmental and organizational goals
Administrative:
o Strategically planned and coordinated schedules for pharmacists and technicians to maximize use of human resources to provide 24/7 pharmacy services at multiple locations
o Performed annual performance evaluations on direct reports
o Participated in recruiting, interviewing, and selecting new hires
o Oversight of technician training schedule with a strong focus on maximizing training hours
o Accurately maintained payroll/timekeeping (Kronos and AS400) records for 70+ staff members
o Provided guidance to staff regarding FMLA, insurance, benefits, PTO, etc.
o Conducted regular technician meetings; assisted with general staff meetings
o Maintained spreadsheets for tracking worked hours to prevent overtime and budget excesses
Revenue Integrity:
o Ensured Pharmacy daily charge capture was maximized per Revenue Integrity policies
o Performed periodic audits to ensure charge capture and minimize the risk of missed charges
o Partnered with Pharmacy Systems Manager and Business Services to proactively address billing problems/questions to ensure accuracy
Corporate Compliance Facility Advisor – maintained quarterly work plan; met with Corporate Compliance Director as needed
Accomplishments:
• Earned Star of the Month for identifying missing charges for one medication - $250,000
• Compiled/wrote technician training manual to assist new hires with training
• Consistently kept worked hours under budget by strategically flexing staff
• Completed IDB on time 100% of the time for 21 years
• Submitted final pay reports on time 100% of the time for 18 years
• Scheduled all pharmacists and technicians for Epic training prior to go-live while maintaining adequate staffing in each area of the pharmacy
Tri County Technical College Adjunct Instructor
• Teach Pharmacy Technician students both on campus and virtually
• Prepare lessons, study guides, and exams as needed
• Provide individual instruction/tutoring as needed
CVS State Certified Pharmacy Technician (PRN)
• Multi-tasking with priority given to providing excellent customer service
• Accurately enter information and fill prescriptions in a timely manner
Revco/CVS Store Manager
• Managing daily operations as well as supervision of all employees
Sonny Ghany – Interim Healthcare: Director of Revenue Cycle
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Lynn Capobianco - CVS Pharmacy manager
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Pat White - AnMed Health Director of Pharmacy (retired0
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